Provider Demographics
NPI:1508985425
Name:DEKALB GASTROENTEROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:DEKALB GASTROENTEROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COHILAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-508-7676
Mailing Address - Street 1:2675 N DECATUR RD
Mailing Address - Street 2:SUITE 506
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6131
Mailing Address - Country:US
Mailing Address - Phone:404-299-1679
Mailing Address - Fax:404-508-7694
Practice Address - Street 1:2675 N DECATUR RD
Practice Address - Street 2:SUITE 506
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6131
Practice Address - Country:US
Practice Address - Phone:404-299-1679
Practice Address - Fax:404-508-7694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID
GA=========OtherTAX ID